Coeliac Disease and Bone Health: The Osteoporosis Link

Does coeliac disease cause osteoporosis?

Yes — coeliac disease is considered a secondary cause of osteoporosis, meaning the bone loss is a downstream consequence of the gut condition rather than a primary bone disease. A 2023 review in Nutrients classes coeliac disease as a secondary osteoporosis risk factor, because damage to the small intestine interferes with how the body takes in the nutrients bones depend on (Nutrients, 2023). The NHS lists osteoporosis — described as a condition where the bones become brittle and weak — among the complications that can follow the malabsorption seen in coeliac disease (NHS, 2023).

How common is low bone density at diagnosis? The honest answer is that estimates vary, and the two figures worth knowing come from different sources and should be kept separate. Coeliac UK notes that low bone mineral density can affect up to 75% of people when they are diagnosed with coeliac disease at any age (Coeliac UK). The 2023 Nutrients review, meanwhile, cites a meta-analysis in which 30–60% of newly diagnosed patients showed low bone density and 18–35% had osteoporosis (Nutrients, 2023). These are group statistics, not a prediction for any one person — but together they show why bones are a genuine part of the coeliac picture. For the wider context on why bones weaken, see our guide to what causes osteoporosis.

Why does coeliac disease weaken bones?

The core problem is malabsorption: when the gut lining is damaged, the body cannot absorb enough calcium — and often vitamin D — to keep bone strong. In coeliac disease, gluten triggers immune damage to the villi, the finger-like folds lining the small intestine. The 2023 Nutrients review explains that this villous damage in the upper small intestine impairs calcium absorption, and that the resulting drop in calcium can drive secondary hyperparathyroidism, which accelerates bone turnover and loss (Nutrients, 2023). A 2024 Nutrients observational study similarly notes that inflammation and villous atrophy compromise the absorption of calcium, protein and other essential nutrients needed for healthy bone (Nutrients, 2024).

Coeliac UK frames the same mechanism plainly: during untreated disease the body cannot absorb the calcium it needs for strong bones (Coeliac UK). Vitamin D matters here too, because it governs how well the body uses calcium — our guide to vitamin D for bone health explains that relationship in more depth.

Can low bone density be how coeliac disease is first found?

Sometimes, yes — because coeliac disease raises osteoporosis risk, an unexplained bone-density result can occasionally be the thread that leads to a coeliac diagnosis. UK guidance from the British Society of Gastroenterology lists osteoporosis among the higher-risk groups in whom testing for coeliac disease should be carried out (Gut, British Society of Gastroenterology, 2014). In other words, the relationship runs both ways: coeliac disease can cause bone loss, and unexplained bone loss can be a reason to check for coeliac disease.

This is not just a statistical point. A patient story published by the Royal Osteoporosis Society describes exactly this route — an individual sent for a DXA scan because coeliac disease raises osteoporosis risk, having learned that coeliac disease can increase the likelihood of osteoporosis through poor calcium absorption (Royal Osteoporosis Society, 2022). If you already have osteoporosis alongside ongoing digestive symptoms, it is reasonable to ask your GP whether coeliac testing might be worthwhile for you.

Can a gluten-free diet improve my bone density?

For many people it can — removing gluten lets the gut heal, calcium absorption recovers, and bone density often improves, particularly in the first year. Coeliac UK states that bone density will usually improve after starting a gluten-free diet (Coeliac UK). The British Society of Gastroenterology goes further, describing a gluten-free diet as the core management strategy for the prevention of osteoporosis in coeliac disease, and noting that bone density increases during the first year of adherence (Gut, British Society of Gastroenterology, 2014). A 2020 review echoes that just one year of a gluten-free diet has been shown to improve objective markers of bone mineral density (Gastroenterology and Hepatology from Bed to Bench, 2020), and the 2023 Nutrients review reports that T-scores improved significantly after a gluten-free diet in the study it cites (Nutrients, 2023).

The recovery is real but not always complete, and appears most reliable when the diet is followed strictly and, plausibly, when coeliac disease is picked up earlier — though a clean dose-response for earlier diagnosis was not established in the sources here. A 2024 Nutrients study observes that, even with rigorous gluten-free adherence, a full recovery of bone density is not always achieved in a significant proportion of people (Nutrients, 2024) — which is precisely why bone health is worth monitoring over time rather than assumed to fix itself.

Should I have a bone density (DXA) scan if I have coeliac disease?

It depends on your individual risk — and in the UK that decision is guided by your clinical team, not a blanket rule. The British Society of Gastroenterology's 2014 guideline recommends that bone density be measured after one year of a gluten-free diet in patients who have additional risk factors for osteoporosis, or who are over the age of 55 (a Grade D recommendation) (Gut, British Society of Gastroenterology, 2014). The same guideline advises that calcium, alkaline phosphatase and vitamin D are measured at diagnosis, and a 2020 review likewise notes that a vitamin D check at diagnosis is part of that assessment (Gastroenterology and Hepatology from Bed to Bench, 2020).

Coeliac UK keeps it simple: your healthcare professional will make recommendations on DEXA scanning at diagnosis and follow-up (Coeliac UK). Because bone density can keep changing over the years after diagnosis, monitoring — not a single snapshot — is what matters; a 10-year cohort study supports repeat DXA assessment over time and describes a roughly two-year scan interval for patients with osteoporosis or risk factors (Internal and Emergency Medicine, 2023). If you want to understand how bone scans are accessed in the UK, our guide to a bone density scan on the NHS walks through the pathway.

Can a REMS scan replace the DXA my clinician recommends?

No — and it is important to be clear about that. REMS (Radiofrequency Echographic Multi Spectrometry) is a radiation-free ultrasound scan that offers a convenient way to establish a baseline and monitor bone health over time. Because it uses no ionising radiation, it can be repeated as often as makes sense for tracking change. What it does not do is replace the DXA bone-density assessment that UK coeliac guidance refers to. If your GP or gastroenterologist has recommended a DXA scan, follow that advice.

Where a REMS assessment fits is alongside the clinical pathway — a way to see where your bones stand and to keep an eye on them between clinical reviews, rather than a substitute for the medical care coeliac disease needs. If that is useful to you, you can read about our bone health assessment or book a radiation-free bone health assessment. Whatever you decide, decisions about diagnosis, supplements and treatment belong with your GP or dietitian.

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This article is part of our bone health series. To understand one of the key nutrients involved, read our guide to vitamin D for bone health.